Sandton Healthcare Limited, a small domiciliary care agency in Stevenage, received an overall Good rating on its first inspection in July 2023, with four key questions rated Good and Well-led rated Requires Improvement. Key governance failures included unsubmitted CQC notifications for safeguarding concerns, inadequate care plan auditing, incomplete risk assessments, and a mental capacity assessment that lacked evidence of the person's involvement.
Concerns (6)
criticalSafeguarding: “The registered manager had not submitted any notifications to CQC at the time of the inspection. Some safeguarding concerns had been referred to the local authority, but CQC were not notified.”
moderateCare planning: “1 person's mobility care plan did not describe how they were supported to mobilise. We also found 1 person was supported by staff with meal preparation and medicines administration, but this was not in line with their care plan.”
moderateGovernance: “Audits of care plans were not as robust; they had not identified the issues we found during the inspection.”
moderateRecord keeping: “The registered manager did not always ensure care plans and risk assessments included up to date detailed guidance for staff and check they followed people's assessed needs.”
moderateConsent / capacity: “The person's capacity assessment did not include evidence of how the person had been involved...it did not describe how the person had been supported to understand or how they had responded.”
moderateCare planning: “Risk assessments had not been completed related to people's environments and 1 person's epilepsy risk assessment did not include detailed action for staff if they had a seizure.”
Strengths
· People spoke positively about staff being kind, caring and respectful of their dignity and independence.
· Electronic monitoring system generated alerts if staff had not logged in within 15 minutes of a visit; no visits had been missed at time of inspection.
· Staff received training including safeguarding, MCA, medicines management, end-of-life care, and specialist training such as PEG feeding.
· Service worked effectively with external health and social care professionals, who praised responsiveness and open communication.
· Managers were supportive of overseas-recruited staff and incorporated cultural considerations into induction.
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Continuous learning and improving careNot rated
well-led: Working in partnership with othersNot rated